INITIAL EXAM (part 1)
- PURPOSE: Convert New Patient into a Rate of Response (ROR) Plan
a) Rate of Response Plan = mini tx plan to see if your patient is going to respond to acupuncture or not - GOAL:
a) Train New Pt to prepay for the 2nd time & their 1st Care Plan b) ROR Plan will help you determine the 1st Care Plan - STATS: ROR Close %
- SCRIPT: “8-Step Initial Exam Protocol”
The 3 Main Questions: - Can you Help me?
- How long will it take?
- How much is it going to cost?
INITIAL EXAM (part 2) 8-Step INITIAL EXAM PROTOCOL
Step 1: Build Rapport (~1 min)
§ (Introduce yourself to patient.) Hi, XXX, I am Szenan. Nice to have you here in our clinic.
§ How did you hear about us? Awesome, that’s great. (Say something nice about the referral. XXX is a very nice person.)
§ Have you had acupuncture before?
(No.) Oh no, You’ve been missing out!
(Yes) Was it for the same issue,where did you go and how was your experience? (If it was bad confirm.) So the acupuncture didn’t help?
§ You: Have you watched the organ video in the reception yet (use your finger point and show them the organ chart so that they know what are you talking bout)? Pt: Yes.
§ You: Awesome, Does it make sense to you? Pt: Yes.
§ You: Great! First, I would like to thank you for filling in the form. In this session, I will go through the form with you and give you a diagnose according to TCM and to find out whether I could help you or not. If I could find the organs imbalance according to TCM that I think I could help you then we will set a treatment goal together, present you a treatment plan and let your know how long it will take? How much it is going to cost?. Do you have anything you want to tell me before we go through your form?
Step 2: Health History Intake (~5-10 min)
§ Let them talk about history. ( if they want to talk, otherwise go the step 3).Only get info that will help us for our treatment. The question to ask yourself is: will this info affect my decision on their treatment plan or change their treatment in any way (if they talk too much and they can’t stop, your way to bring the LEAD back is “awesome, thank you for sharing this with me, let’s get started and focus on your main complaints.)
Step 3: Establish ROR Symptoms (~5 min)
§Go over the list of complaints. Which one is the #1 concern? Show me where the pain is. May I palpate? (Palpate hard to get a reaction and confirm.) I found it. This area is inflamed, swollen, hard. What alleviates the pain? How long do they give you relief? What aggravates the pain? (Perform any assessment tests to get objective measurements.) (Focus on 2 main complaints and establish which one is ROR symptom
Step 4: Establish Life Effect (~5 min)
§ LIFE EFFECT = relates to an ACTIVITY or QUALITY OF LIFE
§ “What is your _______ preventing you from doing, that you want to do and love to do?”
§ “If you didn’t have _______, what would you be doing right now?”
§ “I understand that you can still do everything you want to do and you just push through, but would you like to do more of _______?”
§ “I understand that you’ve got back pain, however most people don’t come to us because they have back pain,
they come to us because their back pain is preventing them from doing something that they love and want to do. Because if your back pain wasn’t preventing you from doing anything that you want to do, you wouldn’t be in my clinic right?”
§ “Give examples of possible Life Effect if the pt is struggling to figure it out for themselves.”
§ How is the pain affecting your quality of life?What is it preventing you from doing that you really want to do?What are some of the things that you want to do or love to do but you can’t because of the pain?If you did not have this pain, what would you be doing right now?(Whatever they say is their Life Effect)
STEP 5: Setting Expectations(5 min)
§ You have tried (other modalities) and they did not help you reach your goal. I understand that you have pain and we will address the pain. Our goal is to help you get to (Life Effect). The way we are going to get to your goal is by eliminating the pain/symptom. I want to know what your expectations are from us. Do you have a time frame that you are hoping that we can help you reach your goal? When do you expect this to get resolved so you can do (Life Effect)
§ Acupuncture is phenomenal for (Main Complaint). Now, if we can help you, it is going to take some time to reach your goal. How long have you been dealing with this? The pain did not happen overnight and we will not be able to get rid of it overnight. It is not going to take the same amount of time to resolve this but it is going to take some time. This can be a few months, or even a year. The reason I’m telling you this is because I want you to have the right expectations. I do not want to mislead you to think that acupuncture is going to take this away in a few days or a few weeks, because it is not. I am not saying that this is going to take a few months for you to get relief. Most of our patients get relief after every treatment. But you are not here just for relief. Right? You are here for a solution, a permanent fix. Right? In order to achieve that, it is going to take some time. Does that make sense? I want to give you the Big Picture of the timeline of when this can be resolved and get you to (Life Effect). Knowing that this is going to take longer than you anticipated, is it still your goal to do (Life Effect)
STEP 6: Exam & Findings (10 min) (use the organ chart to explain anything you get from pulse and tongue)
§Go through the organs and check all organs condition and explain to them what is going on and how do organs link to their main complaint.
Script as following:
You: You have_(name all conditions one by one) and they are caused by __(example sp/st or )__organ imbalance. (go through all 5 organs condition on the form). Your sp/st are controlling muscles strength according to TCM, that is why your muscle pain is not healing or healing very slow.
You: All organs control physical function as well as link to emotional energy, which is very different idea from western medicine, for example Liver and GB out of balance then you would easily get stress, anger, impatience, frustration, irritability and depression according to TCM, however western medicine does not believe in emotional energy link to organ function. Does it make sense to you?
§ Check pulse script
1.“This is called Organ Functional Pulse Diagnosis. It is a tool used in Chinese Medicine to detect how our organs are functioning. Thousands of years ago they didn’t have the diagnostic tools we have today. (Like scan, MRI, CT scan, X ray) They still had to figure out what was going on inside the body and why it wasn’t healing itself. Different sections of the radial pulse corresponds to different organs of the body. You have something flowing through your pulse, what is it? (Blood) Yes, I’m going to feel the blood being pumped to your organs, and it’s going to tell me which organs are out of balance the most.”
2. We know that you have all these conditions and all organs out of balance, but which one should we focus on, your pulse is showing me that we should focus on XXX organ. Don’t get me wrong that we only treat this organ, we are going to treat them all, however we are focusing on this organ or these 2 organs (point on the organ chart again to let them know.) for the start.
Check tongue: (Take a picture of the tongue of the top and bottom, show patient what you have seen and what they mean)
use this following script if you just check tongue WITHOUT pulse
“This is called Organ Functional Tongue Diagnosis. It is a tool used in Chinese Medicine to detect how our organs are functioning. Thousands of years ago they didn’t have the diagnostic tools we have today. (Like scan, MRI, CT scan, X ray) They still had to figure out what was going on inside the body and why isn’t it healing itself. Different sections of the tongue corresponds to different organs of the body.
You see : Teeth marks, coating = weak spleen and st function = water retention, mucus…(show pt picture and point out what is going on the tongue)
Use this following script if you check tongue AFTER pulse
Organ Functional Tongue Diagnosis is similar to functional pulse diagnosis.
You see : Teeth marks, coating = weak spleen and st function = water retention, mucus…(show pt picture and point out what is going on the tongue)
3.Perform additional assessments or exams needed (ex: ROM, strength, nerve exams)
STEP 7: Connect the Dots (2 min)
§ Acupuncture works phenomenal for (Main Complaint). Now how does it work? Acupuncture does 2 things.
- 1)Acupuncture moves the blood and energy. Depending on where we put the needles, we can move blood and energy anywhere in the body. Can you guess where we are going to move the blood and energy for you? Exactly! We are also going to move the blood to the organs that we found in the pulse/tongue diagnosis that are not functioning properly. It is through your organs that your body can heal itself.
- 2)Acupuncture can retrain your brain to move the blood and energy by itself. With acupuncture, we are not trying to replace a function of your body. We are trying to restore a function. Prescription drugs replace the function of your body’s ability to suppress inflammation. Once you stop, all the inflammation will come back. Acupuncture can restore your body’s function to resolve inflammation by itself. It promotes self- healing.
- 3) That is why acupuncture works phenomenal for (Main Complaint). Now will it work for you? Since we have not treated you before, we have no idea how your body is going to respond, but there is a way to find out. Acupuncture is black or white. It will either work for you or it will not. Here is how we are going to find out. We are going to start you off with 3/6 acupuncture treatments. In these 3/6 acupuncture treatments, we want to see a reduction in your pain/symptom. No, your pain/symptom will not go away completely, but we do want to see a reduction. If there is no change after these treatments then acupuncture will not work for you and we will stop. When it does not work for you, we will need to go for just Chinese herbs instead of acupuncture, as Chinese medicine is better for replenish resource in your body. If there is a reduction, then the acupuncture will work. Go and create the ROR plan (mean while play some happy patient review while you creating the ROR plan) (If patient has neuropathy, high blood pressure, intermittent symptoms, ROR is 6 treatments within 2 weeks.)
- 4) The next question that we need to answer is how fast or how slow your body will respond. This is called your rate of response. In our clinic, a fast response is when we stick needles and the pain instantly starts to decrease. A slow response is when we insert needles and there is no change, but later, after you go home, you start feeling better. The latter is called a delayed response. If you have a delayed response, it means that the acupuncture will still work. It will just be delayed. We need to find out which one you are so we can determine the number of treatments you need to fix the problem. Does this make sense? I will tell you that since you have had (Main Complaint) for so many years, it is going to take a few months for you to get significant benefit from acupuncture. The first step is to see how your body is going to respond to these first 3/6 treatments. (Go over and show them the form and read it out one by one to them)
- In order to test your body, you need to come in for 3 treatments in a 7 day period/6 treatments in a fortnight. Is that going to be a problem?” (Yes) Any deviation to this will not give us an accurate assessment of how your body responds to acupuncture. If you come in once a week, it can
make you feel better after 1 treatment. If you come back after a week, your symptoms will come back to where it was before and it’s
like starting from ground zero every single time so it is not going to work. (Pause) - Let’s go over finances. For the 3/6 treatments the total is XXX. Since you are paying out of pocket, we do give a prepaid discount to our
patients who pay out of pocket. If you prepay for all 3/6 treatments TODAY, we will give 40% discount which makes the total XXX.
(Pause) - “Do you have time for a treatment?”
- If internal disorder only and patient cannot come in 3x week, patient can come in 1x week with herbs
- If patient has allergies (or any internal disorder) and has no response to acupuncture, try herbs. Tell patient, their body does not
have enough resources so we need to supply some.
RATE OF RESPONSE (ROR) PLAN DAY 1 TREATMENT
ROR Plan Formulation
§ Constant Pain/Symptom = 3tx within 1 wk
§ Episodic Pain/Symptom = 3tx/wk for 2 wks
DAY 1: Acupuncture Treatment
v Pt is Symptomatic at time of treatment
- Pt gets “Wow” Effect with acu = “That’s awesome, I already know acupuncture is going to work for you, now we just
need to know how long the relief lasts, so pay attention after you go home to when your ______ returs back to its original intensity” - Pt does NOT get a Wow effect = “after you go home today, pay attention to see when your _____ starts to get better.
DAY 2: Acupuncture Treatment
- Pt gets 4+ hours of relief = “That’s awesome, so we already know that your body responds to acu and your body is a fast responder, Nice, let’s keep it rolling”
- Pt gets less than 4 hours relief = “no worries, acupuncture works thru a cumulative effect, so one treatment builds upon the previous one, and this is also why we are doing these 3/6 initial txs to test your body.